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Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists.

Publication ,  Journal Article
Mitchell, JB; Ballard, DJ; Matchar, DB; Whisnant, JP; Samsa, GP
Published in: Health Serv Res
March 2000

OBJECTIVE: This study evaluates the role of neurologists in explaining African American-white differences in the use of diagnostic and therapeutic services for cerebrovascular disease. DATA SOURCES/STUDY SETTING: Medicare inpatient hospital records were used to identify a random 20 percent sample of patients age 65 and over hospitalized with a principal diagnosis of TIA between January 1, 1991 and November 30, 1991 (n = 17,437). STUDY DESIGN: Medicare administrative data were used to identify five outcome measures: noninvasive cerebrovascular tests, cerebral angiography, carotid endarterectomy, anticoagulant therapy (as proxied by outpatient prothrombin time tests), and the specialty of the attending physician (neurologist versus other specialist). DATA COLLECTION/EXTRACTION METHODS: All Medicare claims were extracted for a 30-day period beginning with the date of admission. PRINCIPAL FINDINGS: Even after adjusting for patient demographics, comorbidity, ability to pay, and provider characteristics, African American patients were significantly less likely to receive noninvasive cerebrovascular testing, cerebral angiography, or carotid endarterectomy, compared with white patients, and to have a neurologist as their attending physician. At the same time, patients treated by neurologists were more likely to undergo diagnostic testing and less likely to undergo carotid endarterectomy. CONCLUSIONS: The findings suggest that African American patients with TIA may have less access to services for cerebrovascular disease and that at least some of this may be attributed to less access to neurologists. More research is needed on how patients at risk for stroke are referred to specialists.

Duke Scholars

Published In

Health Serv Res

ISSN

0017-9124

Publication Date

March 2000

Volume

34

Issue

7

Start / End Page

1413 / 1428

Location

United States

Related Subject Headings

  • White People
  • United States
  • Practice Patterns, Physicians'
  • Physician's Role
  • Patient Selection
  • Outcome Assessment, Health Care
  • Neurology
  • Medicare
  • Male
  • Ischemic Attack, Transient
 

Citation

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Chicago
ICMJE
MLA
NLM
Mitchell, J. B., Ballard, D. J., Matchar, D. B., Whisnant, J. P., & Samsa, G. P. (2000). Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists. Health Serv Res, 34(7), 1413–1428.
Mitchell, J. B., D. J. Ballard, D. B. Matchar, J. P. Whisnant, and G. P. Samsa. “Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists.Health Serv Res 34, no. 7 (March 2000): 1413–28.
Mitchell JB, Ballard DJ, Matchar DB, Whisnant JP, Samsa GP. Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists. Health Serv Res. 2000 Mar;34(7):1413–28.
Mitchell, J. B., et al. “Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists.Health Serv Res, vol. 34, no. 7, Mar. 2000, pp. 1413–28.
Mitchell JB, Ballard DJ, Matchar DB, Whisnant JP, Samsa GP. Racial variation in treatment for transient ischemic attacks: impact of participation by neurologists. Health Serv Res. 2000 Mar;34(7):1413–1428.
Journal cover image

Published In

Health Serv Res

ISSN

0017-9124

Publication Date

March 2000

Volume

34

Issue

7

Start / End Page

1413 / 1428

Location

United States

Related Subject Headings

  • White People
  • United States
  • Practice Patterns, Physicians'
  • Physician's Role
  • Patient Selection
  • Outcome Assessment, Health Care
  • Neurology
  • Medicare
  • Male
  • Ischemic Attack, Transient